Lemierre’s Syndrome: The Forgotten Disease?

Lemierre’s Syndrome is characterised by a history of recent sore throat, clinical or radiological evidence of internal jugular vein thrombosis and isolation of anaerobic pathogenstypically Fusobacterium necrophorum. Previously considered a forgotten disease due to widespread use of antibiotics for pharyngeal infections, over the past two decades Lemierre’s Syndrome has become an increasingly common presenting complaint. Emergence of antibiotic resistance may explain the recent rise in the number of reported cases. Lemierre’s Syndrome is associated with significant morbidity and mortality if not diagnosed and treated early. In the pre antibiotic era Lemierre’s syndrome was fulminant and fatal in 90% of cases. The classical presentation of Lemierre’s Syndrome is that of an acute oropharyngeal infection in a young otherwise healthy young adult, followed several days later by fever, rigors and associated lung complications. Treatment involves a prolonged course of antibiotics, the role of concomitant anticoagulation still remains controversial. This article describes treatment and management of a patient diagnosed with Lemierre’s syndrome to illustrate its classical presentation, common pitfalls in diagnosis and optimal management. Our aim is to raise awareness amongst clinicians of this potentially fatal but curable disease.